Basic Information
| Provider Information | |||||||||
| NPI: | 1790978864 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENYINNA | ||||||||
| FirstName: | CHINONYEREM | ||||||||
| MiddleName: | VERONICA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 N 9TH ST | ||||||||
| Address2: | UNIT 519 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191072460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567453257 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8116 GOOD LUCK RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207063502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2409654413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD432569 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | D83677 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.